Editorial | Medicaid matters

A high-stakes game of chicken appears to have ended in Frankfort with the news that one of three for-profit managed care companies selected to run much of Kentucky's Medicaid program has exited the state a year early.

At least for now.

Whether the company, Kentucky Spirit Health Plan, quit or was fired remains in dispute. It's a dispute likely to be fought out in months of grinding and costly litigation.

If the state Cabinet for Health and Family Services is right - that Kentucky Spirit quit and thereby breached its contract - the state could seek millions in damages for the money it could have saved had the company stayed on the job. If Kentucky Spirit is correct, that it was forced out, it could avoid payment and seek damages itself.

It promises to be a lengthy and complicated legal fight.

But the most immediate need is health care for the 125,000 patients covered by Kentucky Spirit.

The state must move quickly and smoothly to move those patients to two other providers hired to manage most of Medicaid outside the Jefferson County region. Managed care, introduced in a budget emergency in 2011 as a way to save millions of dollars, got off to a rough start.

Patients who are finally beginning to see doctors, have treatment authorized and get prescriptions filled don't need to be re-victimized through another trying transition.

And providers - doctors, dentists, pharmacists, therapists - don't need another round of frustrating delays, denials and non-payment of claims that marked the early months of Medicaid managed care in Kentucky.

Cabinet Secretary Audrey Tayse Haynes assured The Courier-Journal that the cabinet has been working - without tripping over legal entanglements - to be ready to move the patients to the other two Medicaid companies, Wellcare and Coventry Cares, when the Kentucky Spirit contract ended. That happened, by the state's determination, one minute after midnight Friday.

To try to ensure a smooth transition, she said the cabinet has been preparing for the departure of Kentucky Spirit, and the other two companies have agreed to do their best to take on the new patients without confusion. The two companies will now be serving about about 525,000 low-income and disabled Kentuckians outside the Jefferson County region.

Medicaid patients in Jefferson and 15 surrounding counties have been in a managed-care plan for 15 years, first served by Passport Health Plan, a non-profit organization, and more recently, through Passport and three for-profit companies.

The state's action to expand managed care statewide got off to a rocky - many would say disastrous - start.

Kentucky Spirit's exit is a setback and the state must work to make sure it does not lead to new disruption.

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Editorial | Medicaid matters

A high-stakes game of chicken appears to have ended in Frankfort with the news that one of three for-profit managed care companies selected to run much of Kentucky's Medicaid program has exited the